Hashimoto Hiroshi, Kushikata Tetsuya, Kitayama Masatou, Ishihara Hironori, Hirota Kazuyoshi, Sakai Tetsuhiro, Futagami Masayuki, Yasujima Minoru, Tsutaya Syouji
Department of Anesthesiology, Hirosaki University School of Medicine, Hirosaki 036-8562.
Masui. 2006 Aug;55(8):1014-7.
We experienced an accidental use of suxamethonium for general anesthesia in a 26-year-old woman with hereditary hypocholinesterasemia that had not been recognized preoperatively. The patient was scheduled for total colectomy as her chronic ulcerative colitis could not be controlled with medications. Routine preoperative screening such as blood cell counts, biochemical data, chest x-ray and electrocardiogram were performed but serum cholinesterase (ChE) activity was not measured. As the preoperative patient condition was good with no abnormal history, anesthesia was induced and maintained with propofol, ketamine and fentanyl as usual. For muscle relaxation, suxamethonium was used for tracheal intubation, and vecuronium was used for the maintenance. After surgery, postanesthetic course was uneventful. One year later, as the patient was pregnant and scheduled for cesarean section, the preoperative screening was done. The biological data showed a hypocholinesterasemia without liver dysfunction. Thus, previous medical records of internal medicine were cheked. Surprisingly the record showed hypocholinesterasemia when she was 15 and 21 years of ages. However, as the physicians did not recognize hypocholinesterasemia, they did not inform the patient of it. Why did the patient have no prolonged apnea and emergence after the previous anesthesia? As the surgical time was exceeded 4 hrs, plasma suxamethonium could fortunately be less than its effective concentration at emergence. However, this case strongly suggests us that preoperative screening should be done without any omission. In addition, if serum ChE activity is not examined, use of suxamethonium should be avoided.
我们遇到了一例意外使用琥珀胆碱进行全身麻醉的情况，患者是一名26岁患有遗传性低胆碱酯酶血症的女性，术前未被识别。该患者因慢性溃疡性结肠炎药物治疗无效而计划行全结肠切除术。进行了常规术前筛查，如血细胞计数、生化数据、胸部X光和心电图检查，但未检测血清胆碱酯酶（ChE）活性。由于术前患者状况良好且无异常病史，像往常一样用丙泊酚、氯胺酮和芬太尼诱导并维持麻醉。为了肌肉松弛，使用琥珀胆碱进行气管插管，使用维库溴铵维持。术后，麻醉后过程顺利。一年后，由于患者怀孕并计划行剖宫产，进行了术前筛查。生物学数据显示存在低胆碱酯酶血症但无肝功能障碍。因此，检查了内科的既往病历。令人惊讶的是，病历显示她在15岁和21岁时就有低胆碱酯酶血症。然而，由于医生未识别出低胆碱酯酶血症，他们未告知患者。为什么患者在上次麻醉后没有出现长时间呼吸暂停和苏醒延迟呢？由于手术时间超过了4小时，幸运的是，在苏醒时血浆琥珀胆碱浓度可能低于其有效浓度。然而，该病例强烈提示我们术前筛查应无遗漏地进行。此外，如果未检查血清ChE活性，应避免使用琥珀胆碱。
